Care for the Whole Patient

Posted on October 7, 2013 at 2:16 pm

Better Access to Medical Care Needed

The primary care patient should have more available access to psychiatry and other behavioral specialties, bringing in the appropriate expertise to treat medical and behavior problems that are inseparable.[1]

Approximately half of the population have symptoms that are consistent with those of recognized psychiatric diagnoses in the DSM-5.1 Of the patients who have been diagnosed with a psychiatric disorder, approximately 70 percent are treated by their primary care physicians, leaving only 30 percent that have ever seen a behavioral therapist or a psychiatrist.1

Fusing Primary and Psychiatric Care Together

As it is well known that patients with psychiatric disorders are at a higher risk of health problems, both need to be treated simultaneously.1 Primary care physicians often see patients whose behavioral problems mask as physical symptoms that cause chronic medical conditions.1 Treating the physical symptoms and not the behavioral problems only leads to a worse outcome for the patient, at risk of developing diabetes, hypertension, cardiovascular problems, obesity, etc.1 However, primary care physicians are not expected to go into great depth regarding behavioral symptoms, and most do not have the time.1

Regarding depression, primary care physicians are confronted with patients with the disorder frequently.1 Many feel comfortable prescribing antidepressants for the common disorder.1 Unfortunately, most times, the dose is too low to be therapeutic.1 Symptoms do not improve and depression persists over longer periods of time.1 The risk of suicide increases and the ability to treat the patient with worsening depression becomes more difficult.1

The same goes for bipolar disorder; however, among primary care providers, diagnosing this disorder is often not done in a timely manner.1 But with seven minutes allowed per patient, how could it be?1 Psychiatrists are equipped with the time and the tools to bring forth accurate diagnoses and effective treatments.1 Our system is demanding too much from primary care providers, who are often underfunded and overtaxed on time.1 When looking to refer patients to a psychiatrist, it is often difficult for a primary care provider to secure the patient an appointment within a timely manner.1

The creation of new systems of medical and behavioral integration may be the solution to this problem.1 It would benefit patients greatly to place the psychiatrist, nurse, social worker, and case manager in the same clinic as their primary care peers.1 Patients would be able to be routinely screened for behavioral symptoms with a standard assessment tools, and if needed, allowing for a quick referral to be made to a psychiatrist within the building.1 It’s time to treat the whole patient, with psychiatrists and primary care physicians working together.1